In the analysis of barriers to HIV prevention, testing and treatment services for marginalized groups, the phrase “stigma and discrimination” dominates the discourse. However, from a feminist perspective, it is important to discuss the root causes of the problem and to discuss how power affects the lack of access. In order to build strong movements and sustain advocacy and activism within and across movements, it is key to challenge power relations that shape exclusion from resources, services and goods, and to advance health for all. Effective advocacy, activism and movement building in turn depend on deliberate, active and robust learning. Intellectual work has to be recognized as central to our advocacy as Africans for access to health and HIV related goods and services and it must be deepened and applied to our work as we advance our movements.

The CAL Conversations on Access to Health in Botswana created the space to do this kind of intellectual work. The conversations were organised into themes which are presented in this report namely: (one) wellbeing, (two) solidarity, (three) funding (four) mental health and (five) sexual and reproductive health and rights. The report ends by pointing out implication for action that emerged from the conversations.

COUNTRY CONTEXT

Botswana has demonstrated a strong national commitment in responding to its HIV and AIDS epidemic and has become an exemplar for many in sub-Saharan Africa. It was the first country in the region to provide universal free antiretroviral treatment to people living with HIV, paving a path for many other countries in the region to follow. The impact of its treatment programme has been widespread. New infections have decreased significantly, from 15,000 in 2005 to 9,100 in 2013, although in recent years they have begun to rise again, with 9,700 reported in 2015. AIDS-related deaths have dramatically decreased from the 14,000 recorded in 2005. They fell to 3,200 in 2015.

Key affected populations and HIV in Botswana

The HIV epidemic in Botswana is widespread although several key populations are hit hardest by HIV. There is an increasing effort at a national level to support these key affected populations, but legal and punitive barriers prevail, making HIV prevention and support efforts challenging.